Common Bile Duct Stricture After Laparoscopic Cholecystectomy: Case Report

Abstract

SUMMARY -Despite progress in laparoscopic surgery and increasing surgical experience, the incidence of bile duct injury during laparoscopic cholecystectomy fails to fall below 0.3%-0.6% and it is still higher than those recorded in the era of open cholecystectomy. Bile duct injuries belong to the most serious complications of abdominal surgery in general and often end up with liver transplantation as the only hope for cure. We present a case of a 78-year-old jaundiced male patient who sustained common hepatic duct injury during laparoscopic cholecystectomy eight months earlier. Exploratory laparotomy, ERCP and MRCP revealed a metal clip placed just below hepatic duct confl uence and causing stricture of bile duct with dilatation of bile ducts proximal to the level of stenosis (Strasberg classifi cation type E3 injury). Repair of the injury was performed by creating termino-lateral hepaticojejunostomy between the right and left hepatic ducts and retrocolic Roux en-Y jejunal limb. By presenting this case, we wish to emphasize the importance of timely conversion and execution of intraoperative cholangiography in all cases when identifi cation of the structures of Calot's triangle is not clear enough. Successful treatment of bile duct injury is only possible with joint approach of radiologist, gastroenterologist and experienced hepatobiliary surgeon.

Recovery from a biliary stricture of a common bile duct ligature injury: A case report

“…Injury of the common bile duct is a severe complication during LC, and it could lead to significant long-term morbidity, including recurrent strictures, inflammation of the biliary tract, and cirrhosis[ 7 ]. There are several causes leading to injury of the common bile duct, including anatomic variations of the extrahepatic bile ducts, inflammatory changes due to cholecystitis, intra-operative bleeding, and lack of surgical experience[ 2 , 8 ]. Biliary injuries that occur during LC are usually more severe than those that occur during open cholecystectomy because injuries are often near to or directly involve the second- and third-order bile ducts[ 8 ].…”

“…Cholecystectomy is a common elective procedure for cholecystic disease, including cholecystitis and cholelithiasis[ 1 ]. Common bile duct injury is a major complication in both open and laparoscopic cholecystectomy (LC)[ 2 ]. With advances in laparoscopic techniques, the incidence of common bile duct injury has decreased to 0.08%–0.42%[ 3 , 4 ]; however, the number of cholecystectomies performed has increased due to popularization and application of the laparoscopic technique, which has led to an increase in the number of bile duct injuries[ 2 ].…”

“…Common bile duct injury is a major complication in both open and laparoscopic cholecystectomy (LC)[ 2 ]. With advances in laparoscopic techniques, the incidence of common bile duct injury has decreased to 0.08%–0.42%[ 3 , 4 ]; however, the number of cholecystectomies performed has increased due to popularization and application of the laparoscopic technique, which has led to an increase in the number of bile duct injuries[ 2 ]. The main reasons for common bile duct injuries are complete transection and incorrect ligation[ 5 ].…”